Page 19 - Delaware Medical Journal - February 2016
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SCIENTIFIC ARTICLE
this group were in placements for which we do not have claims data.
foster care may be in a detention center or with intensive inpatient/ outpatient services provided through PBH (not paid for through Medicaid), these data do not include the screenings that may have occurred with those agencies. If we assume that all children in these alternative placements received a well child visit within 30 days, the total percentage of children that meet the AAP recommendations goes up to 42 percent. It should be noted that, because some or with intensive inpatient/outpatient services provided through PBH (not paid for through Medicaid), these data do not include the screenings that may have occurred within those agencies.
DISCUSSION
To promote the health and well-being of children in foster care,
it is critical that we better understand their health status, current health care utilization, and potential unmet health care needs. This study contributes to our understanding of the health-related needs of children in foster care in the state of Delaware. The results show that children in foster care in Delaware are connected to the health care system, with nearly all receiving at least one health care service during the study period. Further, children in our cohort received more services once they entered the foster care system than before being placed in foster care, suggesting that entry into foster care promotes health care utilization.
The results of this study also highlight areas of ongoing need and concerns related to the health of children in foster care in Delaware. For instance, similar to national trends, children in foster care in Delaware have more behavioral health-related needs compared
with other children in Medicaid. These behavioral health needs translate into higher utilization of psychotropic prescription drugs and lead to higher costs. Further, many children in foster care in Delaware do not appear to be receiving preventive health visits AAP. While this challenge is not unique to Delaware, it is an area that deserves ongoing attention due to the nature and scope of the health needs of this vulnerable population. Building upon the AAP recommendations, the Division of Family Services within DSCYF currently recommends that all children obtain a screening visit, days if possible, or at least within 30 days, upon entry into the foster care system. This is important, as research has shown that state policies can have a positive impact on utilization of preventive care.8
services and psychotropic drugs suggest a need to consider issues
related to coordination of care, particularly in terms of the integration of behavioral health services within primary care. The “medical home” is increasingly viewed as a model of delivering preventive and primary care that is comprehensive, patient- (or family-) centered, coordinated, accessible, and of a high quality. Medical homes have been found to improve the quality of care for vulnerable patients, including promoting higher rates of routine preventive services.9 Medical homes can also promote linkages to social supports
needed to address related social needs among low-income and
other vulnerable populations.10 For these reasons, the medical home children in foster care. Only one state (Illinois) has systematically incorporated the medical home model for children in foster care. Jaudes and colleagues examined the medical home experience of Illinois’ children in foster care compared with other children in the state’s Medicaid program.11 The study found that children in foster departments for chronic conditions.11 Due to the complex medical and behavioral health needs, more attention to implementation of a Additional recommendations, based upon a combination of our Force on the Health of Children in Foster Care and can be found at www.ccrs.udel.edu/node/489.
LIMITATIONS AND FUTURE RESEARCH
This study provided important new information about the health and health care utilization patterns of children in foster care in Delaware; however, it is not without limitations. First, our study was necessarily limited in scope by practical resource constraints (e.g. money and time), and the analysis revealed additional questions that could be explored in future studies. For instance, it would be valuable to explore the health-related needs of children in foster care over a longer period of time. We hope to build on this work using the Medicaid database to conduct a longitudinal analysis, which could provide a more detailed understanding
of the foster care population and allow for potentially more meaningful comparisons. Similarly, it would be useful to explore relationships among different variables in our dataset in more detail and over a longer period of time. It may also be practical to compare the needs of children in foster care in Delaware to those in other states in our region, and use the existing database to help to evaluate new models of care or other kinds of interventions. Finally, concerns raised by others regarding continuity of care12 suggest the need to examine this issue in Delaware to promote better health care for children in foster care in our state.
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